Y HQC VigT NAM THANG 1 - S6' 1/2013 Cac TT thu'dng g3p d Ccic the la kho da d
mat (96,3%); do da toan than (77,8%); TT nep gap, TT Idng ban tay va ban chan. Ion ml (74,1%). TT it gap hdn la bong vay d dau (55,6%). TT mang keo sau sinh (37,0%) g3p d VCBS thong thffdng va DDTT dang VCBS khong ed bpng nffde. TT bpng nffde (3,7%) chi gSp 6 the ODTT dang VCBS cd bpng nydc, bien dang ngdn (11,1%) chi g3p d ttie DDTT dang VCBS khdng ed bpng nffde.
TAI LIEU THAM K H A O
1. Bygum A, Virtanen M, Brandrup F, GSnemo A, Sommerfund M, Strauss G, et al (2012),
"Generalized and Naevoid EpHdennolytic Ichthyosis in
Denmark: Qinical and Mutational Findings", Acts Deim Venereol. Aug 29 2012; fMedlinel.
DiGiovanna, John J. Ichthyosis (2003),
"Ichthyosis: Etiology, Diagnosis, and Managemenf, Amencan Journal of Qinlcal Dermatc^y, 2003 - Volume 4 - Issue 2 - pp 81-95.
D. Hohl, U.W. Schnyder ( 1 9 9 9 ) , Les ichtyoses, Dermatologie et maladies sexuellement transmissibles. Mason, pp 207-212.
Fitzpatrick's Dermatology in general medicine ( 2 0 0 8 ) , "The ichthyoses", pp 402-424.
Thomas P Habif MD ( 2 0 0 5 ) , "Skin disease diagnsis and treatment", Elsevier Mosby. pl67.
W. Sterry, R. Paus, W. Burgdorf (2006), Dermatology, pp 332-339.
NGHIEN CllU OAC DIEM HJNH THAI MOM MdC VA TRAN SANG OUA 95 PHIM CT.SCAN MUI XOANG
Phan Mong Hoang' - Nghiem Dii'c Thu|n'*
TOM
TATMo ta cat ngang 95 phim CT Scan mui xoang tai BV OKKV Gil Chi, chung toi thu dUOc nhCihg ket qua sau: (IJMom moc: type A: 67.4%, type C: 25.2%, type B: 7.4% (Theo Annals of Otology, Rhinology and Laryngology Suppl. 167 - Oct 1995 Vol 104); type 1:
47.3%, type 6: 15.8%, type 2: 12.6%, type 3; 11.6%, type 5: 7.4%, type 4: 5.3% (Theo Landsberg R. &
FriedmanM, Laryngoscope 111) {2)Tran sang:t^pe A:
88.4%, type 8: 6.3%, type D: 4.2%
T y khoa: mom mdc, tran sang
SUMMARY
Study on 95 sinus CT Scans films of uncinate process an roof of ethmoid.
Cross-sectional study: 95 sinus CT Scans filnfis Results: (J)uncinate process: type A: 67.4%, type C: 25.2%, type B: 7.4%
(Annals of Otology, Rhinology and Laryngology Suppl. 167 - Oct 1995 Vol 104); type 1: 47.3%, type 6: 15.8%, type 2: 12.6%, type 3; 11.6%, type 5:
7,4%, type 4: 5.3% (Landsberg R. & FriedmanM, Laryngoscope 111) {2)Roof of ethmokl: type A:
88.4%, type B: 6.3%, type D: 4.2%
Keywords: uncinate process, roof of ethmoid
I.
DAT VAN D IPhau thuat npi soi mui xoang da ehiing minh la phffdng phap dieu trj co hieu qua doi vdi viSm mOt xoang man tinh khong dap ffng vdi dieu trj npi khoa. Tuy nhien, mpt so bien chffng trong luc phau thuat nhff thiing san so, vd xffdng giay van tiem an va day thff thach.
Nghien ciiXi ciia eac tac gia tren The gidi ve mom moc va tran sang cd cac hinh thai sau:
Tran sang (tran xoang sang):
TI
82
-• BVDKKhu vi/c Cu Chi-Tp. Ho Chi Minh; ** Hoc vien quan y.
Phan bien khoa hgc: GS.TS. Le Gia Vinh
Y HQC VigT NAM THANG 1 - SO 1/2013
Cac dang cua tran sang
Type A (tran sang thap): hokh&u sau tit l-3mm; Type B (tran sang trung binh): ho kh&u sau tir 4-7mm; Type C (tran sang cao): hokhub sau tit 8-16mm. Type D: khong co sd doi xdng hai ben cua ban sang.
Nguon: Annals of Otology, Rhinology and Laryngology Suppl.
167 - Oct 1995 Vol 104, No 10, Part 2, pp7-16 Mom moc:
Cac dang bam cua mom moc
Thong thu'dng dau tren cua mom moc bam vao xu'dng giay (A), nhu'ng no co the di len bam vao nen so (B) hoac di vao trong debam vao cuon muigOta (C)
Nguon: Annals of Otology, Rhinology and Laryngology Suppl.
167 - Oct 1995 Vol 104, No 10, Part 2, pp7-15[3]
^
^
Cac dang bam cua mom moc (Landsberg R. & Friedman M, Laryngoscope 111:
Dee. 2001)
Chi'nh vi vay viec nghien cffu mdm mdc va tran sang qua hinh anh CT Scan la het sffc can thiet nham han che den mffe toi da cae bien chffng khach quan do phau thuat ndi soi chyc nang miJi xoang gay ra.
Muc tieu nghien cu'u:
1. Nghien cud dac diem cac kieu bam cua mom moc. Xac dinh ti le cua t^ng kieu bam qua hinh anh CT.Scan mui-xoang.
2. Nghien cu'u dac diem cac ioai tran sang. Xac dinh ti le cua titng loai tran sang qua hinh anh CT.Scan mui-xoang.
II. 001 TUpNG VA PHaONG PHAP NGHIEN Cljru 2.1. Ooi tu'dng nghien cu'u: 95 phim CT Sean mui-xoang dffdc chup tai BV OKKV Cii Chi-TP.HCM ty thang 4 den thang 8/2011.
2.2. Dung cu nghien cu'u: May CT HiSpeed Dual 2 lat eat. Hang GE, san xuat nam 2008, thdi gian bao hanh 5 nam (den 2013).
2.3. Phu'dng phap nghien cu'u: Md ta cat ngang
* Tieu ehuan lya chpn; Tat ea phim CT scan mui-xoang d ngffdi tff 16 tuoi trd len, khdng bi chan thffdng dau-mat, tai Benh vien Oa khoa Khu vffc Cii chi.
* Tieu chuan loai trff: Phim CT scan d benh
nhan bj chan thffdng dau-mat hoac da phau
Y Hpc VigT NAM THANG 1 - Sti 1/2013
thuat npi soi mui xoang.
cdch tien h^nh:
Xdc djnh ki^u bdm va cdc dj dang cua mom m6c:
BWdfc 1: Ghi day dii thong tin tren phieu thu thap sd lieu (bang phu luc).
BWdc 2: Xem tong quat phim CT Sean (de xac djnh benh).
BWdrc3:'A3,c dinh mdm mde ben (P).
Buifc 4: Xac dinh vj tri bam dau tren mom mde (P), tff dd xac dinh: type A, type B hay type C (theo Annals of Otology, Rhinology and Laryngology Suppl. 167 - Oct 1995 Vol 104, No 10, Part 2, pp7- 16[3]); type 1 den type 6 (theo Undsberg R. 8t Friedman M, Laryngoscope 111: Dee. 2001).
Bu'dc5:Gh\ vao bang thu thap so lieu.
Bu'dc 6: Tiep tuc lam nhff vay vdi ben (T) Xac djnh loai tran sang:
Bu'dcl:)(k: djnh tran sang va ho khffdu giac Bu'dc 2: Diing thffdc djnh ehuan trong phan mem dpc phim CT scan de do khoang each tff tran sang den ho khffdu giac.
Bu'dc 3: Tff gia tri do dffdc, xac djnh loai tran sang (loai A, B, C hay D).
Bu'dc 4: Ghi loai tran sang vao bang thu thap so lieu (loai A, B, C hay D).
BWdcS:T\ep tuc lam nhff vay vdi ben (T).
Thu thSp sd' li$u: S6 lieu dydc ghi nhan bSng bang thu thap so lieu (phu lue), hinh anh dydc ghi l?i trffc tiep tren dia mem tai phdng chijp CT scan- BV. OKKV Cii Chi TP.HCM
III. KET QuA vA BAN L U A N 3.1. Tu6i:
- Nhd nhat: 16 tuoi - Ldn nhat: 78 tuoi - < 40 tuoi: 45/95 (47%) - a 40 tuoi: 50/95 (53%)
Qua 95 trffdng hdp dffdc chyp CT Scan mui xoang, ehiing toi nhan thay khong cd sff tap trung d mpt nhdm tuoi, ma phan bo deu tir 16 den 78 tuoi. Dieu nay phii hdp vdi benh ly miji xoang trong thSm kham lam sang.
3.2. Gidi:
- Nam: 36/95 (37.9 %) - Nff: 59/95 (62.1 %)
• Trong mau nghien cu'u ciia chCing toi, ti le Nam/Nff la 2/3, tuy nhien cung khong the ndi la benh ly mui xoang tren lam sang ciia nam ft hdn nff, vi viec co trieu chffng va viec di kham benh de dffdc khao sat bang CT Scan d benh nhan la khdng tffdng dffdng.
3.3. Kieu bam cua mom moc:
Bang l:Chc kieu bam ciia mdm mde (theo Annals of Otology, Rhinology and Laryngology Suppl.
167 • Oct 1995 Vol 104, No 10, Part 2, pp7-16)
Type AType B TypeC Tong so
l ^ n s o 64
7 24 95/95
Ti le ( % ) 6 7 . 4 %
7 . 4 % 25.2 % 1 0 0 %
Oiieu nay cho chung ta thay kha nang say ra bien chffng ton thydng v9 xffdng giay la kha cao neu thao tac phau thuat khong ehuan. Nhin vao so lieu, ta cd the suy doan ti le bien ciiifng khi md mdm mde (type A&B) len den 74.8%.
Bang 2: Cac kieu bam cua mom moc (theo Landsberg R. & FriedmanM, Laryngoscope 111: Dec 2001 Type 1
Type 2 Types Type 4 Type 5 Type 6 Tonq so
Tan so 45 12 11 5 7 15 95/95
Ti ie (%) 47.3 % 12.6 % U.6 % 5.3 % 7.4 % 15.8 % 100 %
Y HQC VI$T NAM THANG 1 • SO 1/2013 3.4. Moi lien
Bang 3: Moi Mdm mdc
Nam Nff Tonq conq
q u a n nguy cd tai bien ciia mom moc theo gi6i.
len quan nquy cd tai bien ciia mdm mde theo qidi Co nguy cd
fTvpe A + TvDC BI 24 47 71
Khdng co nguy cd (Type C)
12 12 21
Tong cong 36 59 95
X2 = 2 ; p=0.1574 > 0.05 ; OR = 0.51 ; CI = 0.18 - 1.45
Nhff vay, nguy ed tai bien d Nam va Nff khae nhau khdng cd y nghTa thong ke.
3.5. Tran sang.
Type A Type B TypeC Type D Tong so
Tan so 83
8 0 4 95
Ti le ( % ) 87.4 %
8.4 % 0 % 4.2 % 100 %
Qua 95 trffdng hdp, chung toi nhan thay tran sang type A chiem da so (87.4%), tiep sau la type B (8.4%), type D (4.2%). Nhff vay ti le tran sang cao (type C) khdng xuat hien trong mau nghien cffu, tuy nhien chung ta that dae biet canh giac vi bien chyng phau thuat ciia no rat nguy hiem.
3.6. Mdi lien quan nguy cd tai bien cua tran sang theo gidi.
Bang 5: Moi lien quan nguy ed tai bien ciia tran sang theo gidi Tran sang
Nam Tonq conq
m
Co nguy cd ( t y p e A + B + C )
8 4 12
Kliong CO nguy CO ( t y p e A)
28 55 83
Tong cong 36 59 95
X2 = 4.83; p = 0.0279 < 0.05; 0R= 3.92; CI- 0.9391 - 19.119
Nguy cd tai bien d Nam la 22.2 % (8/36), d Nff la 6.7 % va sff khac biet nay ed y nghia thong ke (p < 0.05).
IV. KET LUAN
Qua mau nghien cyu 95 phim CT.Scan mui xoang, chiing toi rut ra dffdc nhffng ket luan sau:
4 . 1 . Mom moc:
* Theo phan toai cua Annals of Otology, Rhinology and Laryngoiogy Suppl. 167 - Oct 1995 Vol 104: type A ehiem ti le eao nhat (67.4%), theo sau la type C (25.2%), thap nhat la type B (7.4%).
* Theo phan loai Landsberg R. &
FriedmanM, Laryngoscope 111: Dec. 2001: type 1 cao nhat (47.3%), tiep den type 6 (15.8%), type 2 (12.6%), type 3 (11.6%), type 5 (7.4%) va thap nhat la type 4 (5.3%).
* Nguy cd tai bien d Nam va Nff khae biet khong co y nghTa thong ke.
4.2. Tran sang:
Tran sang type A ehiem da sd (88.4%), tiep sau la type B (6.3%), type D (4.22'o); khong
thay Type C trong mau nghien cyu.
Nguy cd tai bien d Nam la 22.2 % (8/36), d Nff la 6.7 % va sff khac biet nay cd y nghTa thong ke (p < 0.05).
TAI LIEU THAM KHAO
1. Anand V.K. et al (1993). CTofthe nasal cavity and paranasal sinuses and with emphasis on imflammatory disease. Practical endoscopic sinus surgery. Mc Graw-Hill Inc. pp. 42-52 2. Kopp W, Stammberger H, Fotter R.(1988).
Special radiolgic image of the paranasal sinuses.
EurJ Radiol; 8: 152-156.
3 Zinreich SJ, Kennedy DW, Rosenbaum AE, Gayler BW, Kumar AJ, Stammberger H.
(1987). Paranasal sinuses: CT imaging requirements for endoscopic surgery. Radiology;
163: 709-775.
